Recognizing Serious Mental Health Issues in Teens: A Call to Action

Changes in a teenager’s behavior can signal deeper emotional challenges, making it essential for parents to recognize when mood swings may indicate serious issues such as anxiety or depression. The transition can start subtly; a previously enthusiastic teen may express a desire to quit their favorite sport, academic performance may decline, or they may withdraw from friends. These shifts can be difficult to distinguish from typical adolescent moodiness, but understanding the signs is crucial.

According to the National Alliance on Mental Illness, approximately one in six adolescents in the United States experiences a major depressive episode each year. The 2023 Youth Risk Behavior Survey in New Hampshire revealed that 40% of students felt persistently sad or hopeless, with about a third reporting poor mental health most or all of the time.

Dr. Sarah Rocha, a child and adolescent psychiatrist at Elliot Behavioral Health, emphasizes the importance of monitoring behavioral changes. “If you’re seeing a consistent change in your child’s behavior or mood for two weeks or more that seems to be a pattern, that’s when I would really recommend calling your health care provider,” she stated.

Health experts in New Hampshire caution that when a teen’s behaviors begin to disrupt daily activities, it may signal challenges beyond typical teenage angst. Dr. Jennifer McLaren, a pediatric psychiatrist associated with Dartmouth Health Children’s, notes that signs of distress can manifest in various ways. “Some of those signs can be sleeping too much or too little, withdrawing from enjoyable activities, or a decline in school performance,” she explained.

Parents may overlook signs of anxiety or depression, as symptoms can differ significantly between adolescents and adults. William Charmak, a clinical and medical psychologist, points out that while adults commonly exhibit feelings of low self-worth and persistent sadness, adolescence can present differently. “Guilt is not often common in adolescent depression,” he remarked.

Moreover, bullying and social pressures can exacerbate feelings of shame and isolation in teens. Dr. Alexandra Kuftinec, a psychiatrist with over 20 years of experience, notes that girls tend to internalize their emotions, often presenting with physical symptoms like headaches or disordered eating. In contrast, boys may display aggression or engage in risky behaviors.

Anxiety disorders are among the most prevalent mental health issues in teenagers, frequently co-occurring with depression. Dr. Rocha highlights that untreated anxiety can lead to further complications, including post-traumatic stress disorder (PTSD) and other behavioral health issues.

It’s imperative to act early. Delaying care can escalate problems, leading to crises that require immediate intervention. “We see a behavior change, think that it’s just a phase, and we delay seeking care until it becomes a crisis,” Dr. Rocha cautioned.

Primary care providers play a vital role in identifying potential mental health issues during routine checkups. Dr. Kuftinec’s office employs the PHQ-9 Personal Health Questionnaire for Adolescents to assess depressive symptoms over a two-week period. “If symptoms show up more than half the days, it could mean there’s a problem,” she said.

In response to growing concerns about youth mental health, Dartmouth Children’s and the University of New Hampshire have developed the New Hampshire Mental Health Care Access and Pediatrics line. This initiative connects primary care providers with mental health experts, facilitating timely interventions for children in need.

“(The pediatrician) can start interventions we may recommend or help answer any questions,” Dr. McLaren noted. This approach aims to streamline access to care, particularly for those needing immediate support.

For severe cases where a teen poses a danger to themselves or others, inpatient psychiatric care becomes necessary. Finding such care in New Hampshire can be challenging, but improvements have been made. Over the past two years, the state has expanded access to psychiatric services. In April 2025, Dartmouth Health opened a new six-bed adolescent medical psychiatry unit for children aged 12 to 17, enhancing the overall capacity for inpatient care.

Dr. McLaren mentioned, “We’ve had actually no wait list, depending on the time of year, and the wait list has been a lot shorter.”

Parents are encouraged to engage in open conversations with their teens, even if the latter seems reluctant to share. Dr. Rocha suggests asking questions that invite dialogue rather than simple yes-or-no responses. For example, instead of asking if a child feels “good” or “bad,” parents might inquire about changes in their activities or interests.

Connecting with coaches or teachers can also provide insight into a child’s behavior outside of the home, potentially uncovering issues such as bullying or social challenges.

Dr. Kuftinec emphasizes the importance of maintaining connections with children through shared activities, whether it be watching a television show or having regular family dinners. “Having those points of connection and open communication is important,” she said.

Parents should not feel ashamed or overwhelmed by the mental health struggles their children face. Melissa Brule, director of Behavioral Health and Specialty Services at Elliot Hospital, highlighted the complexities of navigating mental health systems in New Hampshire. “If you don’t have a pediatrician that you trust, there are open access hours in all of the community mental health centers that you can walk in and ask for an evaluation,” she advised.

For families connected to Elliot, screenings can typically be conducted within seven days, often via telehealth, making it easier for teens to access care. “This group has no problem getting on their cell phone, and it’s been really helpful for families where the parents are at work,” Brule added.

As awareness of teenage mental health issues grows, early intervention remains paramount. By recognizing the signs and seeking help promptly, parents can support their children in navigating these challenging times.